John Dewey's concept of the good: A macro- and meso-application to the United States health system.

摘要

This work stems from the debate about ethically reforming America's health system in response to the enduring scarcity of resources. There are at least three essential components to successfully instituting needed changes: a philosophically-defensible guideline, effectively-designed programs or legislation, and political willpower. This dissertation represents the first component.; Two distributive justice decisions are central to this dissertation. One decision is how to apportion resources among competing governmental programs such as Social Security, education, agriculture, and transportation. This is known as the macro-level. The other decision is how to apportion health-care resources to competing ailment or disease categories such as cancer, eye care, cystic fibrosis, and burns. This is known as the meso-level.; An ethical criterion or standard is needed with which to make such important decisions. Some proposals choose a consequentialist criterion in terms of the benefits resulting from health while others use a Kantian-like criterion of right action. Still other proposals focus on the notion of a good human life. The criterion selected for this dissertation comes from the philosophical work of John Dewey, an influential American philosopher in the first half of the 1900s. This criterion precedes the aforementioned criteria: it is the concept of the good itself.; Several philosophers have developed comprehensive theories about the good. I considered the theories of Plato, Kant, and Iris Murdoch as well as that of Dewey. Dewey's theory is used herein because it has the greatest potential for engaging or examining the practical case of health-care reform. In other words, the theories of the other three philosophers are less able to evaluate and critique how societal goods and medical treatments are and are not good.; Dewey's concept of the good is applied to the practical macro-level programs of health care, national defense, education, and the arts in order to determine their relative goodness. Dewey's concept is also applied to the practical meso-level programs of prenatal care, kidney dialysis, and assisted reproductive technologies so as to determine their comparative goodness. The outcome of these comparisons is then examined in terms of the impact on distributive decision-making at a public policy level.